Questions & answers · Health insurance
My doctor asked my health plan for prior approval. How long does the plan have to answer?
Health insuranceHow to fileChecked Nov 6, 2026
From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-06 · Source: govinfo CFR 2024 · 29 CFR 2560.503-1 · § 2560.503-1(f)(2)(iii)(A) View original ↗
In short
- Job-based plan: 15 days to answer a request for approval before care.
- Urgent care: 72 hours.
- HealthCare.gov lists 15 days to decide an appeal of a prior-approval denial.
What this means
For a job-based group health plan, the plan must decide an approval-before-care request no later than 15 days after it receives it. It may extend one time by up to 15 days, if it tells you before the first 15 days end [1].
For urgent care, the limit is 72 hours [2].
HealthCare.gov also lists times for an internal appeal. It is within 15 days if you are seeking prior authorization, and within 72 hours for urgent care [3].
Your next step
Ask your doctor's office the date the request was sent. Count 15 days from the date the plan received the request (72 hours if urgent). The deadline in the sources: 15 days (+15 once), 72 hours if urgent.
Check it yourself
Whether your care counts as urgent: "Don't know yet" from these sources. Your own plan papers show whether your plan is job-based or bought on the marketplace.
Where this comes from (3)
[1] govinfo CFR 2024 · 29 CFR 2560.503-1 · § 2560.503-1(f)(2)(iii)(A) · checked 2026-11-06
not later than 15 days after receipt of the claim by the plan. This period may be extended one time by the plan for up to 15 days
[2] govinfo · 29 CFR 2590.715-2719 · § 2590.715-2719(b)(2)(ii)(B) · checked 2026-11-06
in the case of urgent care claims for notification of the plan's benefit determination (whether adverse or not) as soon as possible, taking into account the medical exigencies, but not later than 72 hours after the receipt of the claim
[3] HealthCare.gov · Internal appeals · There are 3 steps … · How long does an internal appeal take? · checked 2026-11-06
Within 15 days if you’re seeking prior authorization for a treatment Within 30 days for medical services already received Within 72 hours for urgent care cases
How we found this
We matched your question to 3 official sources, quoted the exact lines, and re-checked each quote against its source on 2026-11-06.
What we don’t know yet
Your own plan or notice may say something different. If your letter cites another rule, send it and we will look again.
Every answer is checked against the official rule it quotes.
Information only — not legal advice. Your plan, insurer or agency decides.
This answer quotes the official sources listed above, with the date we checked them. Your own policy, notice and state rules control. We are not your lawyer or your insurer. We don’t file, argue or negotiate claims for you — you send any letter or form yourself.
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